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Objective:To explore the prognostic role of baseline 18F-FDG PET/CT metabolic parameters for patients with peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS). Methods:From February 2010 to January 2019, 47 PTCL-NOS patients (29 males, 18 females, age: (59.7±13.6) years) from Nanjing Drum Tower Hospital were retrospectively enrolled. Each patient underwent baseline 18F-FDG PET/CT imaging before treatment. The total metabolic tumor volume (TMTV) and total lesion glycolysis (TLG) were computed by using the margin threshold of 41% SUV max. Kaplan-Meier survival analysis, univariate and multivariate Cox proportional hazards regression models were used to evaluate progression-free survival (PFS) and overall survival (OS). Results:Over the follow-up of 5-119 months, 25 patients had disease progression, including 24 deaths. SUV max (hazard ratio ( HR)=8.581, 95% CI: 1.950-37.764, P=0.004), TMTV( HR=9.677, 95% CI: 3.521-26.593, P<0.001), TLG( HR=3.647, 95% CI: 1.245-10.682, P<0.001) and prognostic index for T-cell lymphoma (PIT; HR=4.593, 95% CI: 1.792-11.773, P=0.002) were significant predictors of PFS and OS( HR=8.720, 95% CI: 1.982-83.354, P=0.004; HR=9.325, 95% CI: 3.423-25.408, P<0.001; HR=3.439, 95% CI: 1.170-10.110, P<0.001; HR=4.437, 95% CI: 1.728-11.393, P=0.002). After multivariate analysis, TMTV was the independent predictor of PFS ( HR=4.371, 95% CI: 1.066-16.541, P<0.001) and OS ( HR=4.978, 95% CI: 1.123-21.329, P<0.001). The substratification analysis showed that patients with high TMTV(≥168.3 cm 3) had worse prognosis than those with low TMTV (<168.3 cm 3) for PFS ( χ2=14.60, P<0.001) and OS ( χ2=16.81, P<0.001) in low PIT (0-1) group, while patients with high TMTV had worse prognosis than those with low TMTV for PFS ( χ2=4.09, P=0.043) in high PIT (≥2) group. Conclusions:Baseline PET/CT metabolic parameters including SUV max, TMTV, TLG and PIT are able to predict survival in PTCL-NOS patients. TMTV is the independent predictor of PFS and OS, which can substratify PTCL-NOS patients in PIT group.
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Objective:To investigate the prognostic value of pretreatment 18F-FDG PET/CT metabolic parameters in patients with elderly classical Hodgkin′s lymphoma (cHL). Methods:From April 2011 to April 2020, the pretreatment clinical and 18F-FDG PET/CT metabolic parameters of 42 elderly cHL patients (29 males and 13 females, median age 69 years) pathologically confirmed in the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were obtained with 41%SUV max as the threshold. ROC curve analysis was applied to obtain the best prognostic cut-off value of SUV max, MTV and TLG. Kaplan-Meier method and log-rank test were used for univariate survival analysis, and Cox proportional hazard regression model was used for multivariate survival analysis. Results:SUV max, MTV and TLG of 42 elderly cHL patients were 16.49(12.24, 23.59), 79.29(26.29, 184.51) ml and 729.02(206.03, 2 073.98) g, respectively. ROC curve showed that the AUCs of SUV max, MTV and TLG were 0.425, 0.882 and 0.832, respectively, and the best prognostic cut-off values were 16.49, 82.38 ml and 556.26 g, respectively. Univariate analysis showed that age, B symptoms, lactate dehydrogenase (LDH) level, Hb content, Ann Arbor stage, German Hodgkin Study Group (GHSG) score, MTV and TLG were relative factors affecting progression-free survival (PFS) rate ( χ2 values: 4.50-12.60, all P<0.05), and age, B symptoms, LDH level, Ann Arbor stage, GHSG score, MTV and TLG were relative factors affecting overall survival (OS) rate ( χ2 values: 5.20-11.17, all P<0.05). Multivariate analysis showed that MTV (relative risk ( RR)=5.370, 95% CI: 1.697-16.277) and TLG ( RR=4.854, 95% CI: 1.228-23.352) were independent prognostic predictors of PFS rate (both P<0.05), and GHSG score ( RR=3.761, 95% CI: 1.092-12.955; RR=3.668, 95% CI: 1.068-12.571), MTV ( RR=6.173, 95% CI: 1.431-16.322) and TLG ( RR=5.162, 95% CI: 1.200-22.199) were independent prognostic predictors of OS rate (all P<0.05). Conclusion:MTV and TLG in pretreatment 18F-FDG PET/CT are independent prognostic factors for predicting PFS and OS in patients with elderly cHL patients, which have certainly reference value for prognosis.
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Objective:To explore the value of 18F-FDG PET/CT in detecting Richter syndrome (RS) in chronic lymphocytic leukemia (CLL) patients. Methods:From August 2010 to November 2019, 101 histologically confirmed CLL patients (62 males, 39 females; age (58.0±12.7) years) who underwent PET/CT in Nanjing Drum Tower Hospital and the First Affiliated Hospital of Nanjing Medical University were retrospectively included. ROI was drawn and PET/CT images were semi-quantitatively examined by estimating SUV max. Mann-Whitney U test was used to compare the SUV max of RS and non-RS patients. ROC curve analysis was utilized to analyze the optimal cut-off value of SUV max in detecting RS. Results:RS was histologically confirmed in 27 CLL patients. The SUV max of RS patients was 13.7(11.0, 20.1), which was significantly higher than that of non-RS patients (4.1(3.1, 5.8); z=-6.48, P<0.001). ROC curve analysis identified the optimal cut-off value of SUV max was 10.0 and the AUC was 0.923, with accuracy of 94.1%(95/101), sensitivity of 85.2%(23/27), specificity of 97.3%(72/74), positive predictive value of 92.0%(23/25) and negative predictive value of 94.7%(72/76). Conclusion:As the semi-quantitative index measured by 18F-FDG PET/CT, SUV max can help to diagnose RS and provide important information for clinical use.
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Objective To investigate the characteristics of primary mediastinal large B-cell lymphoma (PMBL) in 18F-fluorodeoxyglucose (FDG) PET/CT imaging.Methods From July 2010 to April 2019,18F-FDG PET/CT images of 27 patients (10 males,17 females,median age 31 (19-57) years)with pathologically confirmed PMBL from the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed.The location,shape,density,presence of necrosis and calcification,and invasion around or beyond the lesions were observed.The maximum standardized uptake value (SUVmax),metabolictumor volume (MTV) and total lesion glycolysis (TLG) were measured by automatic segmentation algorithm method.Spearman correlation analysis was used to evaluate the correlation between SUVmax or MTV or TLG and the maximum diameter or Ann Arbor staging.Results The lesions appeared as anterior mediastinal huge masses in 27 patients,and grew in the anterior mediastinal cross-regionally in 25 patients,lobulated at the edge in 24 patients.Low-density necrosis lesions were found in 18 patients.The lesions were surrounded by large blood vessels in 15 patients and tracheae were compressed in 12 patients.Lung tissues were invaded in 3 patients,abdominal lymph nodes and bone marrow were invaded in 1 patient,and no splenomegaly was found in 27 patients.The maximum diameter,SUVmax,MTV and TLG were (11.6±3.7) cm,21.07(15.78,25.09),190.43 (130.14,350.75) cm3 and 2165.54 (1465.86,4185.21) g,respectively.There was no correlation between SUVmax and the maximum diameter of lesions (rs =-0.305,P =0.122),while MTV and TLG were positively correlated with the maximum diameter (rs values:0.741,0.532,both P＜0.05).The maximum diameter,MTV and TLG were positively correlated with Ann Arbor staging (rs values:0.394,0.413,0.422,all P＜0.05),while SUVmax was not (rs=0.031,P＞0.05).Conclusions PMBL mostly presents as large anterior mediastinal mass with the high 18F-FDG uptake in 18F-FDG PET/CT imaging,and the focal necrosis is common,while abdominal lymph nodes,spleen and bone marrow invasion are rare.MTV and TLG of lesions positively correlate with Ann Arbor staging.
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Objective@#To investigate the characteristics of primary mediastinal large B-cell lymphoma (PMBL) in 18F-fluorodeoxyglucose (FDG) PET/CT imaging.@*Methods@#From July 2010 to April 2019, 18F-FDG PET/CT images of 27 patients (10 males, 17 females, median age 31 (19-57) years) with pathologically confirmed PMBL from the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. The location, shape, density, presence of necrosis and calcification, and invasion around or beyond the lesions were observed. The maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were measured by automatic segmentation algorithm method. Spearman correlation analysis was used to evaluate the correlation between SUVmax or MTV or TLG and the maximum diameter or Ann Arbor staging.@*Results@#The lesions appeared as anterior mediastinal huge masses in 27 patients, and grew in the anterior mediastinal cross-regionally in 25 patients, lobulated at the edge in 24 patients. Low-density necrosis lesions were found in 18 patients. The lesions were surrounded by large blood vessels in 15 patients and tracheae were compressed in 12 patients. Lung tissues were invaded in 3 patients, abdominal lymph nodes and bone marrow were invaded in 1 patient, and no splenomegaly was found in 27 patients. The maximum diameter, SUVmax, MTV and TLG were (11.6±3.7) cm, 21.07 (15.78, 25.09), 190.43 (130.14, 350.75) cm3 and 2 165.54 (1 465.86, 4 185.21) g, respectively. There was no correlation between SUVmax and the maximum diameter of lesions (rs=-0.305, P=0.122), while MTV and TLG were positively correlated with the maximum diameter (rs values: 0.741, 0.532, both P<0.05). The maximum diameter, MTV and TLG were positively correlated with Ann Arbor staging (rs values: 0.394, 0.413, 0.422, all P<0.05), while SUVmax was not (rs=0.031, P>0.05).@*Conclusions@#PMBL mostly presents as large anterior mediastinal mass with the high 18F-FDG uptake in 18F-FDG PET/CT imaging, and the focal necrosis is common, while abdominal lymph nodes, spleen and bone marrow invasion are rare. MTV and TLG of lesions positively correlate with Ann Arbor staging.
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Objective To investigate the prognostic value of metabolic parameters calculated from pretreatment 18 F-fluorodeoxyglucose (FDG) PET/ CT images in patients with extranodal natural killer/ T cell lymphoma (ENKTL) of stage Ⅰ-Ⅱ. Methods From August 2010 to April 2018, 67 patients with ENKTL of stage Ⅰ-Ⅱ disease (47 males, 20 females; median age 57 years) in the First Affiliated Hospital of Nanjing Medical University were enrolled, and the clinic data and pretreatment 18 F-FDG PET/ CT imaging data were retrospectively analyzed. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of tumor tissue were calculated from PET/ CT images with the threshold value of 40％ of maximum standardized uptake value (SUVmax ). The optimal cut-off values of progression-free survival (PFS) and overall survival (OS) of SUVmax , MTV and TLG were investigated by using receiver operating characteristic (ROC) curve analysis. Kaplan-Meier method, log-rank test and Cox proportional hazards model were used for data analy-sis. Results SUVmax , MTV and TLG of 67 patients were 12.32(8.65, 16.96), 13.13(7.37, 22.74) ml, 92.17(46.54, 198.46), respectively. ROC curve analysis showed that the cut-off values of SUVmax , MTV and TLG were 13.09, 18.05 ml and 152.81, respectively. Univariate analysis showed that B symptoms, lac-tate dehydrogenase (LDH) level, β2-microglobulin, Eastern Cooperative Oncology Group (ECOG) score, Korean prognostic index (KPI), SUVmax , MTV, TLG and treatment mode (chemotherapy or chemoradio-therapy) were relative factors affecting PFS (χ2: 5.466-27.163, all P<0.05). B symptoms, LDH level,β2-microglobulin, EB virus (EBV)-DNA, extra-cavitary extension, ECOG score, KPI, MTV, TLG and treatment mode were relative factors affecting OS (χ2: 4.022-34.774, all P<0.05). SUVmax was not the in-fluencing factor of OS(χ2 = 2.766, P>0.05). Multivariate analysis showed that ECOG score, MTV and TLG were independent prognostic predictors of PFS (relative ratio (RR): 5.107- 6.802, all P< 0.05), and ECOG score, MTV, TLG and treatment mode were independent prognostic predictors of OS (RR: 0.221-9. 106, all P<0.05). Conclusions MTV and TLG from pretreatment 18 F-FDG PET/ CT images are inde-pendent prognostic factors for PFS and OS in patients with ENKTL of stage Ⅰ-Ⅱ. MTV and TLG may be more useful than SUVmax for prognosis.
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Objective@#To explore the imaging manifestation and clinical characteristics of primary salivary gland-type lung cancer using 18F-fluorodeoxy glucose (18F-FDG) positron emission tomography/computed tomography (PET-CT).@*Methods@#From March 2009 to January 2017, 12 patients with pathologically confirmed primary salivary gland-type lung cancer were enrolled in First Affiliated Hospital of Nanjing Medical University. Their images and clinicopathological data were retrospectively analyzed.@*Results@#Six out of 12 patients had mucoepidermoid carcinoma (MEC), and the other six patients had adenoid cystic carcinoma (ACC). Five MEC were located in the main bronchus, and the other one was in segmental bronchus. Intrabronchial nodule or mass with smooth or lobulated margin and calcification(n=3) was the main 18F-FDG PET-CT features of MEC. Two ACC involved trachea, two involved the main bronchi, and the other two involved lobular bronchi. The main 18F-FDG PET-CT features of ACC were diffuse or circumferential irregular thickness of the bronchial wall, distorted lumen, and the longitudinal extent of the tumor was greater than its transverse axis. The 18F-FDG uptake of all lesions was increased in varying degree. The median (25th percentile, 75th percentile) value of maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were 5.1(3.1, 8.1), 5.7(1.2, 21.4)cm3 and 18.6(0.6, 93.7), respectively. All of them were related to pathological grading and nodal tumor involvement( all P<0.05), but not associated with tumor location or pathological type( all P>0.05). MTV and TLG were also related to clinical stage( all P<0.05). Tumor size was correlated with MTV, TLG of primary lesions(r=0.607, P=0.036; r=0.579, P=0.049), but not with SUVmax(r=0.568, P=0.054).@*Conclusions@#Primary salivary gland-type lung cancer mainly occurs in segmental bronchus. The MTV and TLG of the tumor calculated by 18F-FDG PET-CT are correlated with clinicopathological characteristics, and are helpful for clinical diagnosis and treatment.
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Objective@#To investigate the prognostic values of the maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) calculated from pretreatment 18F-fluorodeoxy glucose (18F-FDG) PET-CT results of patients with advanced extranodal NK/T cell lymphoma (ENKTL).@*Methods@#The clinic data, follow-up data and pretreatment 18F-FDG PET-CT data of 45 patients with ENKTL of stage Ⅳ were collected. The optimal cutoff value of progression-free survival (PFS) of SUVmax, MTV and TLG were analyzed by using receiver-operating characteristic (ROC) curve. The Kaplan-Meier method, Log-rank test and COX proportional hazards model were used for survival analysis, univariate analysis and multivariate analysis, respectively.@*Results@#The median SUVmax, MTV and TLG of 45 ENKTL patients were 17.98, 70.18 and 755.42, respectively. ROC curve showed that the area under the curve (AUC) of SUVmax, MTV and TLG were 0.504 (P=0.970), 0.868 (P<0.001) and 0.848 (P=0.001), respectively. The value of SUVmax was too small to fit for calculating the cutoff value of AUC. The cutoff value of MTV was 42.54 (sensitivity =78.1% and specificity =84.6%), and the cutoff value of TLG was 435.15 (sensitivity=75.0% and specificity =76.9%). Univariate analysis showed that lactate dehydrogenase (LDH) level, epstein-barr virus (EBV)-DNA, Eastern Cooperative Oncology Group (ECOG) score, bone marrow, Korean prognostic index (KPI), MTV, TLG were significantly related with PFS (all P<0.05), and lactate dehydrogenase (LDH) level, EBV-DNA, ECOG score, primary tumor location, KPI, MTV, TLG were significantly related with overall survival (OS) (all P<0.05). Multivariate analysis showed that KPI, MTV and TLG were independent prognostic predictors of PFS and OS (all P<0.05).@*Conclusions@#MTV and TLG of pretreatment 18F-FDG PET-CT are independent prognostic factors for PFS and OS of patients with advanced ENKTL. MTV and TLG may be more fit for evaluating the prognosis of ENKTL patients than SUVmax.
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Objective@#To investigate the prognostic value of metabolic parameters calculated from pretreatment 18F-fluorodeoxyglucose (FDG) PET/CT images in patients with extranodal natural killer/T cell lymphoma (ENKTL) of stage Ⅰ-Ⅱ.@*Methods@#From August 2010 to April 2018, 67 patients with ENKTL of stage Ⅰ-Ⅱ disease (47 males, 20 females; median age 57 years) in the First Affiliated Hospital of Nanjing Medical University were enrolled, and the clinic data and pretreatment 18F-FDG PET/CT imaging data were retrospectively analyzed. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of tumor tissue were calculated from PET/CT images with the threshold value of 40% of maximum standardized uptake value (SUVmax). The optimal cut-off values of progression-free survival (PFS) and overall survival (OS) of SUVmax, MTV and TLG were investigated by using receiver operating characteristic (ROC) curve analysis. Kaplan-Meier method, log-rank test and Cox proportional hazards model were used for data analysis.@*Results@#SUVmax, MTV and TLG of 67 patients were 12.32(8.65, 16.96), 13.13(7.37, 22.74) ml, 92.17(46.54, 198.46), respectively. ROC curve analysis showed that the cut-off values of SUVmax, MTV and TLG were 13.09, 18.05 ml and 152.81, respectively. Univariate analysis showed that B symptoms, lactate dehydrogenase (LDH) level, β2-microglobulin, Eastern Cooperative Oncology Group (ECOG) score, Korean prognostic index (KPI), SUVmax, MTV, TLG and treatment mode (chemotherapy or chemoradiotherapy) were relative factors affecting PFS (χ2: 5.466-27.163, all P<0.05). B symptoms, LDH level, β2-microglobulin, EB virus (EBV)-DNA, extra-cavitary extension, ECOG score, KPI, MTV, TLG and treatment mode were relative factors affecting OS (χ2: 4.022-34.774, all P<0.05). SUVmax was not the influencing factor of OS(χ2=2.766, P>0.05). Multivariate analysis showed that ECOG score, MTV and TLG were independent prognostic predictors of PFS (relative ratio (RR): 5.107-6.802, all P<0.05), and ECOG score, MTV, TLG and treatment mode were independent prognostic predictors of OS (RR: 0.221-9.106, all P<0.05).@*Conclusions@#MTV and TLG from pretreatment 18F-FDG PET/CT images are independent prognostic factors for PFS and OS in patients with ENKTL of stage Ⅰ-Ⅱ. MTV and TLG may be more useful than SUVmax for prognosis.
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Objective@#To investigate the prognostic value of the maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) measured by pretreatment 18F-FDG PET-CT in patients with stage Ⅲ~Ⅳ diffuse large B-cell lymphoma (DLBCL).@*Methods@#Clinical data of 72 DLBCL patients with stage Ⅲ~Ⅳ disease undergoing a pretreatment PET-CT scan were retrospectively analyzed. SUVmax, MTV and TLG values of whole-body tumor were calculated from PET-CT images with a threshold of SUVmax 40% of tumor tissues. The optimal cutoff lines of SUVmax, MTV and TLG were obtained by ROC curve analysis. The Kaplan-Meier method and Log-rank test were used to perform univariate survival analysis, while Cox proportional hazards model was done for multivariate analysis.@*Results@#The SUVmax, MTV and TLG of 72 patients were 21.64, 139.48 cm3 and 1 413.77, respectively. The areas under the ROC curve (AUC) of SUVmax, MTV and TLG were 0.411 (95%CI=0.279~0.544, P=0.195), 0.688 (95%CI=0.566~0.811, P=0.006) and 0.526 (95%CI= 0.469~0.672, P=0.123), respectively. The median SUVmax (21.64) and TLG(1 413.77) were used as the cutoff lines due to smaller AUC. The cutoff point of MTV was 69.71 cm3. For DLBCL patients of stage Ⅲ~Ⅳ disease, univariate analysis showed that SUVmax and TLG were not associated with the progression-free survival (PFS) and overall survival (OS) (P>0.05 for all). Multivariate analysis showed that National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) but not MTV was the independent prognostic predictor of PFS and OS (P<0.05 for all). And MTV was not the independent prognostic factor of PFS and OS for stage Ⅲ DLBCL (P>0.05 for all).@*Conclusions@#For DLBCL patients with stage Ⅲ~Ⅳ disease, the prognostic value of SUVmax, MTV and TLG before treatment initiation are undetermined, and these indices cannot be used to predict the prognosis.
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Objective@#To explore the imaging presentation of 18F-FDG PET-CT and clinical characteristics of the patients with lymphoblastic lymphoma (LBL).@*Methods@#The clinical and imaging data of 18 patients with newly diagnosed LBL in the First Affiliated Hospital with Nanjing Medical University from July 2009 to June 2017 were retrospectively analyzed. The sensitivity, specificity and accuracy of 18F-FDG PET-CT to diagnose bone marrow involvement (BMI) was calculated respectively.@*Results@#There were 18 LBL patients, including 12 male and 6 female with median age of 24.5 (14-51) years old. Eleven patients were T-LBL, and 7 patients were B-LBL. All lesions were presented with high 18F-FDG uptake on 18F-FDG PET-CT imaging, with a median SUVmax of 14.3 (10.6, 16.8). The most frequent lymph node involvement site was mediastinal lymph nodes, and 7 T-LBL cases had jugular node involvement. The most frequent extranodal involvement site was bone marrow, with multifocal FDG accumulation in bone marrow on 18F-FDG PET-CT imaging in 8 cases. The median SUVmax of node and extranodal involvement were 15.0 (9.0, 18.2), 12.3 (8.4, 15.3), and there was no significant difference (Z=-0.867, P= 0.386). The median SUVmax of T-LBL and B-LBL patients was 14.1 (9.2, 15.9), 14.5 (12.1, 19.5) respectively, and there was no significant difference (Z=-0.679, P= 0.497). According to clinical features, 18F-FDG PET-CT and bone marrow biopsy (BMB), 12 patients were diagnosed as BMI. If multifocal FDG accumulation and diffuse hypermetabolism of FDG in bone marrow were considered as the diagnosis criteria, the sensitivity, specificity and accuracy of PET-CT was 91.7% (11/12), 66.7% (4/6), 83.3% (15/18), respectively. The parameters in BMB were 50.0% (6/12), 100.0% (6/6), 66.7% (12/18), respectively.@*Conclusions@#LBL mostly occurs in young men and its clinical manifestations include lymphadenectasis and invasion of bone marrow. 18F-FDG PET-CT has certain characteristics which are helpful to diagnose and staging.
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Objective To validate the value of 18F-fluorodeoxyglucose (FDG) uptake on PET/CT and thyroid transcription factor-1 (TTF-1) expression to predict the epidermal growth factor receptor (EGFR)mutations in lung adenocarcinoma.Methods From May 2012 to May 2016,a total of 137 lung adenocarcinoma patients (89 males,48 females,age range 33-84 years) pathologically proved were reviewed retrospectively.EGFR mutation testing,TTF-1 expression and PET/CT scan were performed for all patients.x2test was used to assess the differences of EGFR mutation in different groups.Two-sample t test was used to compare the differences of maximum standardized uptake value (SUVmax) between EGFR mutation type and EGFR wild type,TTF-1 positive and negative expression.Multivariate logistic regression analysis was used to test the univariate models that yielded the best predictors of EGFR mutation receiver operating characteristic (ROC) curve analysis was performed to quantify the predictive value of those factors.Results EGFR mutation was identified in 53 patients,including 2 cases in exon 18,19 cases in exon 19,3 cases in exon 20 and 29 cases in exon 21.The high risk factors of EGFR mutation were female (x2=7.465,P=0.006),non-smoking (x2=7.193,P=0.007) and positive expression of TTF-1 (x2=9.104,P＜0.05).The SUVmax of EGFR mutation type was significantly lower than that of EGFR wild type (8.76±4.59 and 11.20±5.09;t =2.832,P =0.005).Multivariate analysis showed that the lower SUVmax (SUVmax ＜8.65) and positive expression of TTF-1 were the independent risk factors for EGFR mutation (P=0.032,P=0.018).The combined use of SUVmax and TrF-1 yielded a higher area under the ROC curve (area under curve=0.697),suggesting a good discrimination.Conclusion The combined evaluation of 18F-FDG uptake and expression of TTF-1 may be helpful in predicting EGFR mutation status in patients with lung adenocarcinoma,especially when the genetic testing is not available,and can provide meaningful clues for clinical treatment.
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Objective To investigate the correlation of clinicopathological features and maximum standardized uptake value (SUVmax) detected by 18F-FDG PET-CT in pulmonary large cell neuroendocrine carcinoma(LCNEC).Methods The clinicopathological data of 43 pulmonary LCNEC patients who underwent 18F-FDG PET-CT and were confirmed by pathology in the First Affiliated Hospital with Nanjing Medical University From October 2009 to May 2017 were retrospectively analyzed.Univariate and multivariate analyses were performed on factors that may affected SUVmax in the primary tumor,including the patient's age,gender,tumor location,tumor type,tumor maximum diameter,T stage,N stage,M stage,and TNM stage.Results The SUVmax and tumor maximum diameter of 43 pulmonary LCNEC patients were 11.9 ±4.9 and (3.2±1.4) cm,and there was a positive relation between SUVmax and tumor maximum diameter (r =0.533,P =0.000).The univariate analysis showed that SUVmax was correlated with tumor maximum diameter,T stage,N stage,M stage and TNM stage (all P ＜ 0.05),but was not correlated with patient's age,gender,tumor location,and tumor type (all P ＞ 0.05).The multivariate analysis showed that tumor location,N stage,M stage and TNM stage were the independent influencing factors of SUVmax (OR =2.087,2.852,2.315,-2.200,all P ＜ 0.05).Primary tumor SUVmax had predictive value for lymph node metastasis,when the cut-off value was 13.5,the diagnostic efficiency was the highest,the sensitivity was 64.7 ％,and the specificity was 92.3 ％.Conclusions The SUVmax detected by 18F-FDG PET-CT in pulmonary LCNEC is correlated with tumor maximum diameter,N stage,M stage and TNM stage.Primary tumor SUVmax has a certain reference value for predicting lymph node metastasis.
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Objective To investigate the prognostic value of SUVmax , SUVmean , MTV and TLG cal-culated from 18 F-FDG PET/CT in patients with postoperative esophageal cancer. Methods Sixty-one pa-tients ( 51 males, 10 females;age ranged 50-81 ( median:64) years) with esophageal cancer who under-went preoperative 18 F-FDG PET/CT from October 2007 to November 2015 were retrospectively analyzed. The relation of SUVmax , SUVmean , MTV and TLG in primary lesions with clinic pathological factors was ana-lyzed. Differences of metabolic parameters were compared with two-sample t test, one-way analysis of vari-ance, Mann-Whitney u test or Kruskal-Wallis H test. The optimal cutoff points of SUVmax , SUVmean , MTV and TLG for predicting overall survival ( OS) were investigated by ROC curve analysis. The Kaplan-Meier method and log-rank test were used to perform univariate survival analysis, and Cox proportional hazards model was used for multivariate analysis. Results MTV and TLG were associated with tumor length, N stage and clinical stage, while SUVmax and SUVmean were only associated with tumor length ( t=-2.396, F=4.206, 4. 471;z=-3.051,χ2=8.908, 9.796;t=-2.417,-2.423;all P<0. 05) . The optimal cutoff points of SUVmax, SUVmean, MTV and TLG were 11.76, 7.06, 24.35 cm3 and 166. 84 g, respectively. Univariate analysis of OS showed that the lymphatic metastasis, clinical stage and TLG were all significantly associated with the patient outcome (χ2=14.683, 7.139, 11.669, all P<0.05) . Multivariate analysis showed that lym-phatic metastasis and TLG were the independent predictors for OS (β=-1. 472, -1. 223; Wald=5. 224, 4. 668;both P<0.05) . Conclusion For predicting the prognosis of esophageal cancer after operation, TLG of the primary tumor may be more valuable than SUVmax , SUVmean and MTV.
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Objective To investigate the clinical value of Fluorine-18-fluorodeoxyglucose (18 F-FDG) PET/CT examination to predict the prognosis of patients with pancreatic cancer.Methods The retrospective cross-sectional study was conducted.The clinicopathologic data of 104 patients with pancreatic cancer who were admitted to the First Affiliated Hospital of Nanjing Medical University between February 2009 and November 2015 were collected.All the patients underwent preoperative 18F-FDG PET/CT examination.The maximum standardized uptake value (SUVmax),metabolism of volume (MTV) and total lesion of glycolysis (TLG) in primary lesion were calculated.According to the patient's condition,chemotherapy,operation and comprehensive therapy were performed.Observation indicators included:(1) results of imaging examination before treatment;(2) treatment and follow-up;(3) analysis of prognosis factors of patients with pancreatic cancer.Follow-up using outpatient examination and telephone interview was performed to detect survival of patients up to June 2016.Measurement data with skewed distribution were represented as median (range).The survival curve was drawn by the KaplanMeier method and the Log-rank test was used for survival analysis.The univariate analysis and multivariate analysis were respectively done by the Log-rank test and COX proportional hazards model.Results (1) Results of imaging examination before treatment:the 18 F-FDG PET/CT imaging of 104 patients with pancreatic cancer showed the slightly hypodense shadow with inordinately uptake of 18F-FDG,with an unclear boundary.The contrast-enhanced CT showed slight enhancement and hypodense,and partial lesions surrounding adjacent vessels can merge with peripheral enlarged lymph nodes.There were high 18F-FDG uptakes of lymph node metastases,hepatic metastases,adrenal metastases and bone metastases.Of 75 lesions of pulmonary metastases,23 showed high 18F-FDG uptakes and 52 showed no high 18F-FDG uptakes.The SUVmax,MTV and TLG in primary lesion of 104 patients were 7.41 (range,2.00-31.65),14.86 cm3(range,2.17-79.65 cm3) and 66.34 (range,5.31-598.22),respectively.(2) Treatment and follow-up:of 104 patients,12 underwent single operation,13 underwent operation + chemotherapy,53 underwent single chemotherapy and 26 underwent chemoradiotherapy.All the 104 patients were followed up for 7.0-88.0 months,with a median time of 26.0 months.The median survival time,6-months and 1-year survival rates of 104 patients with pancreatic cancer were respectively 7.1 months (range,1.0-42.7 months),52％ and 26％.Results of further analysis showed that the median survival time,6-months and 1-year survival rates were respectively 6.5 months (range,1.4-39.6 months),49％,27％ in 51 patients with carcinoma of head of pancreas and 7.2 months (range,1.0-42.7 months),54％,30％ in 53 patients with carcinoma of pancreatic body and tail.(3) Prognosis factors of patients with pancreatic cancer:results of univariate analysis showed that sex,CA19-9,maximum diameter of tumor,lymph node metastases,hepatic metastases,distant metastases,clinical staging,surgery,chemotherapy,comprehensive treatment,SUVmax,MTV and TLG were related factors affecting prognosis of patients with pancreatic cancer [HR =1.603,1.657,2.017,1.873,2.668,1.822,2.157,2.054,2.154,3.208,1.596,2.096,3.411,95％ confidence interval (CI):1.029-2.499,1.045-2.626,1.305-3.115,1.181-2.971,1.735-4.101,1.453-2.285,1.257-3.703,1.245-3.387,1.399-3.317,2.047-5.028,1.052-2.421,1.372-3.201,2.181-5.335,P＜0.05].Results of multivariate analysis showed that distant metastases,chemotherapy,comprehensive treatment and TLG ≥ 66.34 were independent risk factors affecting poor prognosis of patients with pancreatic cancer (HR=1.906,2.966,2.946,2.053,95％CI:1.201-3.022,1.775-4.956,1.753-4.951,1.104-3.820,P＜0.05).(4) Prognostic factors of patients with carcinoma of head of pancreas:results of univariate analysis showed that maximum diameter of tumor,tumor invading major vessels,hepatic metastases,distant metastases,clinical staging,surgery,chemotherapy,comprehensive treatment,SUVmax,MTV and TLG were related factors affecting prognosis of patients with carcinoma of head of pancreas (HR=2.282,2.320,4.125,5.753,6.155,2.841,4.144,3.131,2.229,2.064,5.380,95％ CI:1.231-4.230,1.098-4.903,1.993-8.539,2.682-12.341,1.850-20.483,1.362-5.926,2.106-8.154,1.545-6.345,1.202-4.132,1.121-3.803,2.630-11.004,P＜0.05).Results of multivariate analysis showed that chemotherapy and TLG ≥ 66.66 were independent risk factors affecting poor prognosis of patients with carcinoma of head of pancreas (HR=7.953,2.824,95％CI:3.110-20.338,1.005-7.932,P＜0.05).(5) Prognostic factors of patients with carcinoma of pancreatic body and tail:results of univariate analysis showed that hepatic metastases,distant metastases,surgery,comprehensive treatment,MTV and TLG were related factors affecting prognosis of patients with carcinoma of pancreatic body and tail (HR =2.083,2.501,3.464,2.295,2.231,3.572,95％CI:1.157-3.784,1.363-4.590,1.441-8.329,1.158-4.546,1.166-4.268,1.901-6.711,P＜0.05).Results of multivariate analysis showed that distant metastases,MTV≥ 15.70 em3 and TLG ≥ 62.75 were independent risk factors affecting poor prognosis of patients with carcinoma of pancreatic body and tail (HR =1.700,2.096,4.047,95％CI:1.080-2.675,1.065-4.126,2.072-7.906,P＜0.05).Conclusion TLG≥66.34,≥66.66,≥62.75 in 18F-FDG PET/CT examination are independent risk factors affecting poor prognosis of patients with pancreatic cancer or pancreatic head cancer or pancreatic body and tail cancer respectively,and MTV ≥ 15.70 cm3 is also an independent risk factor affecting poor prognosis of patient with pancreatic body and tail cancer.18 F-FDG PET/CT examination has certainly reference value for prognosis of patients with pancreatic cancer.
ABSTRACT
Objective@#To investigated the prognostic value of 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) in extensive-stage small cell lung cancer (ES -SCLC).@*Methods@#Fifty-five patients with ES-SCLC who underwent pretreatment 18F-FDG PET-CT were retrospectively recruited in this study. The correlations of maximum standardized uptake value (SUVmax) of primary lesion, metabolic tumor volume (MTV) of primary lesion (MTVp), total lesion glycolysis (TLG) of primary lesion (TLGp), the highest SUVmax of all lesions, the sum of metabolic volume (MTV sum), the sum of total lesions glycolysis (TLGsum) and clinical factors were analyzed.@*Results@#The SUVmax, MTVp, TLGp, the highest SUVmax, MTVsum and TLGsum of 55 patients were 11.34±7.02, 29.61 cm3, 207.72, 13.61±7.10, 123.57 cm3 and 988.48, respectively. The SUVmax of primary lesion, MTVp and TLGp were correlated with tumor type and the maximal tumor length, respectively(all P<0.05). The correlations were also found between MTVp, TLGp and hydrothorax, respectively(both P<0.05). MTVsum and TLGsum were correlated with number of lesions, hydrothorax, LDH, hemoglobin and ECOG, respectively(all P<0.05). The association was also found between TLGsum and the maximal tumor length (P=0.039). 51 patients were progressive or recurrent with the median 6.9 months of progression free survival (PFS); and 50 patients were died with the median 11.7 months of overall survival (OS). Univariate analysis showed that MTVsum, TLGsum, number of lesions, ECOG, live metastasis, bone metastasis, the cycle of chemotherapy and thoracic radiation therapy were all associated with PFS and OS (all P<0.05); LDH and hemoglobin were only associated with PFS(both P<0.05). Multivariate analysis demonstrated that LDH, ECOG, live metastasis, the cycle of chemotherapy, MTVsum, TLGsum were the independent predictors of PFS (all P<0.05); and ECOG and TLG sum were the independent predictors of OS (all P<0.05).@*Conclusions@#18F-FDG PET-CT has certain prognostic value of patients with ES-SCLC. MTVsum and TLGsum are the independent predictors of PFS, and TLGsum is also an independent predictor of OS.
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Objective@#To investigate the value of maximum Standardized Uptake Value(SUVmax), Metabolic Tumor Volume (MTV) and Total Lesion Glycolysis (TLG) calculated from 18F-FDG PET-CT in predicting the presence of epidermal growth factor receptor (EGFR) mutations in lung adenocarcinoma.@*Methods@#We retrospectively reviewed 137 lung adenocarcinoma patients with EGFR mutations testing and pretreatment 18F-FDG PET-CT. Receiver Operating Characteristic (ROC) curve analysis was performed to quantify the predictive value of SUVmax、MTV、TLG. A multivariate logistic regression analysis was used to evaluate the predictive value of EGFR mutation.@*Results@#Among 137 lung adenocarcinoma patients, 86(62.8%, 86/137) were identified with EGFR mutations. The SUVmax, MTV and TLG were 7.4, 5.28 cm3, 20.20, respectively. The optimal cut-off values of SUVmax, MTV and TLG were 7.99(AUC=0.658, 95% CI=0.566~0.752, P=0.002), 6.09 cm3(AUC=0.644, 95% CI=0.550~0.737, P=0.005), 35.08(AUC=0.650, 95% CI= 0.557~0.744, P=0.003), respectively. Multivariate analysis showed that TLG and smoking status were the most significant predictors of EGFR mutation(all P<0.05).@*Conclusion@#TLG in 18F-FDG PET/CT is an independent factor for predicting EGFR mutation in patients with lung adenocarcinoma, and has certain reference value for predicting EGFR mutation.
ABSTRACT
Objective@#To investigate the relationship between metabolic parameters of primary lesion and clinicopathological features of patients with breast cancer.@*Methods@#Clinical data of 78 patients with breast cancer undergone 18F-FDG PET/CT before surgery was retrospectively analyzed. SUVmax, SUVmean and metabolic tumor volume (MTV) of primary lesions were measured by horizontal, sagittal and coronal position volume section with a threshold of 40% SUVmax. TLG was calculated and the highest SUVmax among metastatic lymph nodes was measured.@*Results@#SUVmax, SUVmean, MTV, TLG and the maximum diameter of 78 primary lesions were 6.64(1.85, 22.79), 3.88(1.30, 11.42), 13.36(1.66, 129.08)cm3, 47.92(2.85, 443.28)g and 2.35(1.23, 9.80)cm, respectively. SUVmax of metastatic lymph node was 5.12(2.38, 14.32). There were statistically significant differences of primary lesion metabolic parameters (SUVmax, MTV, TLG) in different pathological stages, T stages, with or without lymph node invasion (all P<0.05). Only TLG of ER negative patients was higher than that of ER positive patients (P<0.05). TLG, MTV of PR negative patients were higher than that of PR positive patients (both P<0.05). No significant differences of metabolic parameters were found between HER-2 negative and positive patients (all P>0.05). SUVmax, MTV, TLG of primary lesion were positively associated with Ki-67 and the maximum diameter (all P<0.05), and the correlation coefficient of TLG was the highest. SUVmax, SUVmean, MTV and TLG were all positively associated with T stage (all P<0.05), and the correlation coefficient of TLG was the highest. None of the parameters had correlation with N stage(all P>0.05). Only TLG had positive correlation with clinical stage (P<0.05). SUVmax of metastatic lymph node was positively associated with metabolic parameters of primary lesion, T stage and clinical stage, respectively (all P<0.05).@*Conclusions@#18F-FDG PET/CT metabolic parameters, especially TLG has the highest correlation with clinicopathological features of breast cancer. SUVmax of metastatic lymph node was positively associated with metabolic parameters of primary lesion and clinical stage.
ABSTRACT
Objective To investigate the relationship between metabolic parameters of 18F-FDG PET-CT and cilinicopathological features of patients with lung squamous cell carcinoma. Methods The study comprised 118 patients with lung squamous cell carcinoma. All patients undergone 18F-FDG PET-CT before surgery. Maximum standardized uptake value (SUVmax) and metabolic tumor volume (MTV) were measured, and total lesion glycolysis (TLG) was calculated. Relationship between metabolic parameters and clinicopathological factors was analyzed. Results SUVmax, MTV and TLG of 118 primary lesions were 11.93 (3.12-41.46), 27.71 cm3 (0.54-347.10 cm3) and 153.13 (1.65-2219.37), respectively. SUVmax was related to tumor differentiation degree and pleural invasion (χ2= 15.358, P= 0.000; Z= -2.875, P= 0.004); MTV was related to tumor differentiation degree, pleural invasion, vascular invasion and lymphatic metastasis (χ2= 13.341, P= 0.001; Z= -2.855, P= 0.004; Z= -2.683, P= 0.008; Z= -3.951, P= 0.000), TLG was also related to these clinicopathological factors (χ2= 15.609, P= 0.001;Z= -3.901, P= 0.002;Z= -2.311, P=0.021;Z= -3.721, P= 0.000). T stage and TNM stage had positive correlation with all metabolic parameters (r= 0.326, 0.794, 0.732;r= 0.358, 0.718, 0.668; all P< 0.05). And for N stage, SUVmax was no correlative (r=0.125, P=0.107), but MTV and TLG were positively correlative (r=0.399, 0.371, both P< 0.05). According the MTV or TLG and tumor size, patiens were divided into three groups: low-risk group, moderate-risk group and high-risk group. Significant differences were found among the three groups not even in MTV model, but also in TLG model (χ2= 20.800, P= 0.000; χ2= 20.069, P= 0.000). Conclusions Metabolic parameters of lung squamous cell carcinoma primary lesion have good correlation with clinicopathological factors, and can reflect partial characteristics of the tumor pathology in a certain extent. Furthermore, the probability of lymphatic metastasis could be predicted by MTV or TLG combined with tumor size.
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Objective To investigated the prognostic value of 18 F-FDG PET/CT in patients with limited-stage small cell lung cancer (LS-SCLC). Methods Sixty-six patients (58 males, 8 females;median age 65 years) with LS-SCLC who underwent pretreatment 18 F-FDG PET/CT from April 2009 to December 2015 were included in this retrospective study. The relations between the SUVmax , the sum of MTV ( MTVsum ) , the sum of TLG ( TLGsum ) and clinical factors were analyzed. ROC curve was plotted to estimate the most discrimination threshold ( cutoff point) for each parameter to maximize the sensitivity and specifici-ty in predicting the progression or recurrence. Kaplan-Meier method and log-rank test were used to perform univariate survival analysis and Cox proportional hazards model for multivariate analysis. Results The SUVmax, MTVsum and TLGsum of 66 patients were 10.57±3.27, 38.71(2.89, 221.68) cm3 and 267.04 (1167, 1684.13), respectively. SUVmax, MTVsum and TLGsum were all associated with hydrothorax, the maximum diameter of tumor, clinical stage and LDH. MTVsum and TLGsum were also associated with tumor type and NSE. During the median 33 months of follow-up, 4 patients were lost to follow-up, 43 patients were progressive or recurrent with the median PFS of 12.30 months, and 38 patients died with the median OS of 15.75 months. The optimal cutoff point of SUVmax, MTVsum and TLGsum were 10.08, 16.18 cm3, 209.14, re-spectively. Univariate analysis showed that hydrothorax, the maximum diameter of tumor, clinical stage, NSE, LDH, surgery, MTVsum and TLGsum were all associated with PFS and OS. SUVmax was associated with PFS, but not with OS. Multivariate analysis demonstrated that NSE, LDH, MTVsum and TLGsum were the in-dependent predictors of PFS ( HR:3.83, 4.46, 9.26, 3.87, all P<0.05) , and LDH, MTVsum were also the independent predictors of OS ( HR:2.77, 6.83, both P<0.05) . However, SUVmax was not the independent predictor of PFS(HR=1.47, P>0.05). Conclusions 18F-FDG PET/CT can predict the prognosis of pa-tients with LS-SCLC. SUVmax is correlated with PFS, MTVsum and TLGsum are independent predictors of PFS, and MTVsum is also an independent predictor of OS.